Modern - Blog Science Connections

1.0r-l-~
0.9
Standard Risk
(n' 35)
c=
o
0.8
VI
VI
E
CI>
0:::
c=
0.7
c:n
c=
c= 0.6
'" E
CI>
0:::
(; 0.5
o------~ ..................................................
High Risk
(n = 17)
.&:J
~ 0.4
o
.....
a..
CI>
>
-:; 0.3
::l
E
::l
U
0.2
0.1
o Less than 5 patients remaining
after this point
Fig. 3. Disease-free interval
0.0 .....__......___'--__......__.....1___.......__.....1.__---' systemic+ remission includes
o 10 20 30 40 50 60 70 bane marrow and testicular
Mon t h s
relapse only
severity; there were no related c1inical
manifestations;
4. Hepatic toxicity occurring in 11 patients as
evidenced by increased liver enzymes, particularly
the SGOT. However, the peak
SGOT was less than twice the normal level
and returned to normal in all cases; and
5. Transient maculopapular rashes occurring in
three cases and lasting for several days.
No case of renal toxicity was noted.
The overall regimen has been very weIl
tolerated. There has been no life-threatening
toxicity and no deaths secondary to IDM.
Furthermore, there have been no cases of
leukoencephalopathy and no interstitial pneumonia
associated with IDM. One adolescent
experienced anaphylaxis with the first dose of
L-asparaginase. There have been neither infectious
deaths nor toxic deaths far any patient
while in remission on this study.
F. Discussion
The c1inical data upon which this study was
based was that of the early work of Djerassi
who demonstrated the effectiveness of high
doses of MTX in ALL (Djerassi et al. 1967).
CALGB Protocol6601 demonstrated that the
greatest proportion of children remaining in
complete sustained remission were those who
received the intensive cyc1es of IV MTX (18
mg/m 2 ) daily for 5 days every 2 weeks (i.e.,
they received 90 mg/m 2 as a total dose every
2 weeks) and reinduction pulses of vincristine
and prednisone for aperiod of 9 months
(Holland 1976). In addition, CALGB Protocol
6801 demonstrated that "prophylactic" IT
MTX during induction was important in decreasing
the overt CNS leukemia. Furthermore,
Habhbin et al. (1975) reported data suggesting
that intensive systemic chemotherapy
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